痴呆患者的药物使用调查分析

Medication Investigation and Analysis of Dementia Outpatients

调查我院就诊的1 456名诊断为特定痴呆类型患者处方信息,对患者年龄、性别、诊断、用药种类、频率进行统计分析,总结该类患者潜在用药问题及药学服务关键内容,为该病药学服务提供依据。结果显示,阿尔兹海默痴呆(AD)患者女性占比(65.8%)显著高于男性的34.2%。随患者年龄增长及程度的加重,痴呆精神行为症状(behavioral and psychological symptoms of dementia,BPSD)发生率提高:48.7%的≥80岁患者及59.7%的中重度痴呆患者具有BPSD相关诊断。在所调查的3种主要痴呆类型中,血管性痴呆(VD)患者神经保护/脑部代谢改善类辅助药物使用率最高(38.4%)。针对伴发BPSD症状,AD患者选择性5-羟色胺再摄取抑制剂(SSRIS)使用率最高(23.4%);帕金森痴呆(PD)患者非典型抗精神病药物使用率最高(13.5%)。在调查处方中,痴呆主要治疗药物及针对BPSD的多种药物联用方案存在不良反应/中枢抑制,存在药物叠加作用、药物相互作用、药物依赖、停药反应等潜在用药风险。药师应在药学服务中予以特别关注,确保痴呆患者用药安全合理。

Prescription data of 1456 outpatients with diagnosed dementia in different types were collected and analyzed in the respects of age, gender, diagnosis and medication in classification and frequency distributions. Key points in pharmaceutical care and potential problems were summarized to provide references for pharmaceutical care in dementia patients. There were more female patients (65.8%) than male patients (34.2%) in the AD group. The rates of behavioral and psychological symptoms of dementia (BPSD) were increased with age and gravity of diagnoses. BPSD were diagnosed in 48.7% patients with age over 80 years and 59.7% patients with the diagnosis of moderate/severe dementia. Among the three main investigated dementia types, most VD (38.4%) patients used ancillary drugs for neurometabolic improvements. More AD patients (23.4%) used SSRIS and more PD patients (13.5%) used atypical antipsychotics to cope with BPSD. Several major therapeutic drugs for dementia and drug combinations for BPSD had potential problems such as adverse reactions/central inhibition, drug superposition, drug interactions, drug dependence and withdrawal reactions, which should be noticed by pharmacists in pharmaceutical care to guarantee the rationality and safety of medication in dementia patients.